Outpatient Child/Adolescent Psychiatry
The major task of this assignment is for the resident to gain proficiency in diagnosing and treating a variety of children and adolescents with a wide range of psychiatric disorders. CAP fellows rotate through five outpatient clinics, during which they conduct patient intakes with interviewing, developing differential diagnosis and formulation, and continuing in longitudinal management of the case as part of the fellows’ growing outpatient panel. Fellows are assigned two supervisors for weekly supervision. The outpatient clinics are as follows:
- ADHD Clinic
- Mood and Anxiety Disorder Clinic
- OCD Clinic
- Trauma Clinic
- Psychotherapy / Family Therapy Clinic
Floating Hospital for Children is the full-service children’s hospital of Tufts Medical Center, located in downtown Boston and with partnerships in the community. The 94-bed children’s hospital offers pediatric inpatient and outpatient services in every medical and surgical specialty – from general pediatric services to the care of the most complex cancers, heart diseases and traumas. The focus and mission every day is to improve the lives of children and their families, by treating each child as if they are our own.
The Floating Hospital is the principal children’s hospital for Tufts University School of Medicine, where all our physicians hold faculty positions. Specialists from our children's hospital in Boston are among the most talented and highly trained professionals in the country. We conduct significant research and offer clinical trials for children, particularly for children who have cancer.
CAP Fellowship Rotations at Floating Hospital for Children
This six-month rotation gives fellows a chance to learn about a variety of Pediatric Neurological syndromes and disorders. Fellows attend Pediatric Neurology Outpatient Clinic with Pediatric Neurology fellows, medical students, Neurology residents, and Psychiatry residents at Floating Hospital.
The CCSN works with infants, children and adolescents who have developmental, behavioral, or emotional issues that interfere with growth and/or functioning. CAP fellows rotate with the CCSN for ½ day per week during the first year of fellowship, and gain experience working with children with developmental delay and autism spectrum disorder. Fellows work with the CCSN’s team of Developmental-Behavioral Pediatricians, Psychologists, Education Specialists, and Neurologists to evaluate and work with patients and families served by the CCSN, and receive group supervision.
Fellows may also attend ABC Clinic where they can observe a team and family approach for autistic children. This clinic uses a consultation model to make recommendations for families where their autistic child presentation has been refractory to treatment. Fellows only observe this clinic and do not have expectation of carrying out the treatment.
CAP fellows gain experience in the role of consultation/liaison with pediatric colleagues at Floating Hospital for Children. Fellows evaluate children with serious medical illnesses, including on the inpatient pediatric ward, the pediatric ICU, and the Pediatric Bone Marrow Transplant Unit / Hematoloy & Oncology service. CAP fellows also support emergency evaluations of children in the Tufts MC Emergency Department and serve a teaching role with the Tufts MC Adult Psychiatry residents. Tufts MC fellows also collaborate with Cambridge Health Alliance CAP fellows, who also rotate on our Tufts MC C/L service.
- Child Psychiatry Consultation/Liaison Service
Preschool Rotation: YMCA Preschool
This rotation is designed for CAP fellows to gain experience in focusing on normal early child development, through observation of normal developmental period and child interactions. CAP fellows complete this rotation ½ day per week.
Cambridge Health Alliance
This three-month inpatient child psychiatry rotation is completed during the first year of fellowship at Cambridge Hospital Child Assessment Unit (CAU) and Adolescent Assessment Unit (AAU). The major goals of this rotation are to gain experience and knowledge in assessment, diagnosis, formulation and treatment planning for children and adolescents requiring hospital level of care, and work with a multidisciplinary team. The clinical management in the hospital milieu will include individual, group, family work and pharmacological treatment. The education during this rotation is enhanced with weekly interviewing seminars with seasoned faculty, including Dr. Timothy Dugan, Dr. Judy Tsafrir, and Dr. John Sargent.
St. Ann’s Home & School
1st year Child and Adolescent Psychiatry Residents will spend three months at the St. Ann’s Home in Methuen, MA. They will provide care on the CBAT and short term residential treatment unit. Children between the ages of 5-12 years receive 24 hour care in this unit and are admitted there with significant emotional and behavioral problems and commonly with developmental trauma, and who require continuous care but are not at acute imminent risk of harm. Diagnoses are similar to those seen on an inpatient unit but also include children with significant learning difficulties and academic problems in school. Children generally are in this program for 2-4 weeks. Residents will be responsible for admission, rounds, treatment team meetings, family meetings, discharge planning and collaboration with schools. Residents will also coordinate milieu treatment and organize team based collaboration. Residents will be supervised by two Board Certified Child and Adolescent Psychiatrists at St. Ann’s Home with at least 2 hours of supervision weekly. Competencies to be gained are similar to those gained on the inpatient rotation but also include organizing the milieu treatment and coordinating discharge planning.
Lowell Juvenile Court Clinic
The major objective is to learn techniques for providing effective child/adolescent psychiatric consultation within a court clinic setting, including the provision of psychiatric testimony. This consultation is provided at the Lowell Juvenile Court Clinic. The resident is able to do the following:
- Review the problem with the hospital attorneys, referring judge, other attorneys, guardian Ad Litem, or probation officer
- Obtain pertinent information from legal documents, e.g. briefs, arrest warrants, prior court testimony, and police reports
- Learn to psychiatrically evaluate and diagnose children/adolescents who are adjudicated to the court
- Learn about the specific legal aspects regarding child/adolescent psychiatry, e.g. Child Abuse Petitions, Adjudicating a Child as an Adult, termination of Parental Rights, Commitment, Custody (physical and legal), Incarceration, Legal Rights, Tarasoff Issues, and Miranda Law
- Recognize symptoms and syndromes of a variety of disorders commonly seen in court clinic consultations including Conduct Disorder, Anti-Social Personality Disorder, Substance Abuse, Organic Brain Disorders, Psychosis, Borderline Personality Disorders, Bipolar Disorder, Major Depressive Disorders, Temporal Lobe Syndrome, Sequelae of Head Trauma, and ADHD
- Understand the court committed child/adolescent regarding involvement of family, community, and schools
- Understand the role, demands, expectations, and environment of the court and its staff
- Learn to provide accurate, concise, jargon-free psychiatric testimony
- Learn how a courtroom functions in terms of rules of order, hierarchy, type of legal proceedings and hearings, e.g. Civil, Probate, Criminal, and Federal
Community Psychiatry: Boston STARR program (Stabilization, Assessment, & Rapid Reintigration)
This rotation provides experience in community psychiatry in a consultation role to the Boston STARR Program, a short-term residential program with the Department of Children & Families. Residents at the Boston STARR program are male youth, and commonly struggle with issues of domestic violence, community violence, ADHD, trauma, and mood disorders. Fellows act as consultants to the STARR program and conduct assessments of individual youth and provide recommendations.
School Consultation: Josiah Quincy Elementary School
The major objective is to learn the techniques for effective psychiatric consultation at the request of teachers, principals, guidance counselors, and special education personnel. Within the school, residents are able to gain experience in the following:
- Reviewing problems with the referring special education personnel, administration, and teachers who know the child
- Recognizing those disorders encountered in a school setting such as Learning and Language Disorders, PDD, Major Depressive Disorders, ADHD, Eating Disorders, Organic Brain Disorders, Mental Retardation, and Bipolar Disorders
- Becoming familiar with problems often encountered in the school-aged population (e.g. school absence, school phobia/avoidance, and disruptive behavior)
- Understanding the role of the family, teachers, principal, and special education staff within the school milieu
- Providing verbal and written reports to the school staff while maintaining appropriate confidentiality